Budget 2015: money for PCEHR reboot is to last four years

The $485 million that will be allocated to rebooting the PCEHR in tomorrow's federal budget will be spread over four years, meaning funding levels are on par with previous years.

Federal health minister Sussan Ley announced yesterday that the government was committed to the system, which is set to be renamed the myHealth record, but intended to swap over to an opt-out model as recommended by the Royle review in 2013.

The government will also wind up the operations of the National E-Health Transition Authority (NEHTA) and transfer its role – and the operation of the PCEHR itself – to a new Australian Commission on eHealth (ACeH).

A spokeswoman for the Department of Health said ACeH will be established as a statutory authority in the form of a corporate Commonwealth entity and will operate under similar accountabilities as other Commonwealth agencies, meaning it will subject to Freedom of Information (FOI) rules. A chair for the new agency has not yet been selected or appointed, she said.

The spokeswoman said the new opt-out model will be trialled in at least two places, the location and size of which are also undecided.

“In an opt-out trial the people involved in the trial will have an eHealth record created for them unless they opt out of the system,” the spokeswoman said.

“The local population would be advised in advance how the system worked, the benefits and the process to opt out if that’s their choice. After this period, a record would be created for everyone that hadn't opted out.”

She said a trial was necessary as it was important that the government trial the implementation of opt-out to ensure public confidence in the system is maintained.

“[It] will also assist in evaluating the effectiveness of associated public awareness and information dissemination and education and training for healthcare providers.”

A decision is yet to be made about who will provide the training and education services, she said.

Shadow health minister Catherine King said Labor would look at the results of any trial on changing the system from opt-in to opt-out, but wanted the government to get on with supporting the system almost 18 months after receiving the Royle review.

“Opting out of eHealth was the recommendation of the review on eHealth the government received over 500 days ago, and is only acting on now,” Ms King said.

“The expert review found that eHealth records were a piece of critical national infrastructure. The review found eHealth could save the health system $7 billion a year through fewer diagnoses, treatment and prescription errors, and in the process avoid thousands of unnecessary hospital admissions.

“Labor will look at the results of any trials on changing the system from opt in to opt out, but what is most needed now is a government, and a minister prepared to abandon politically driven attacks on eHealth and wholeheartedly get behind the scheme.”

RACGP president Frank Jones said the college supported an integrated eHealth system and had long argued for one, but it needed to see more detail on the current proposals.

“The RACGP will be closely examining the federal government’s myHealth Record announcement and is keen to see detail around where the $485 million will be allocated and whether training for GPs to learn the new system will be provided,” Dr Jones said.

“It will be critical to review the fine detail as many medico-legal issues are as yet unresolved.”

He said the RACGP supports the trial of an opt-out system so that future policy can be based on evidence.

“The trial must be led by GPs and other clinicians, not bureaucrats based in Canberra,” he said.

The RACGP also supports replacing NEHTA with a new Australian Commission for eHealth. “However, the new commission must have appropriate governance and key health sector stakeholder representation, including the RACGP,” he said.

“Under the current arrangement, the NEHTA only represents and responds to the state and territory governments.”

A spokesperson for the AMA said it was also waiting for more detail on the proposals before commenting.

Comments

So now we have no NEHTA. A good idea as the previous model did not work and what have we been left with as a result of the investment in that organisation?“A chair for the new agency has not yet been selected or appointed, she said.” I guess there is a ‘watch this space’ because where are the NEHTA people going to?“The spokeswoman said the new opt-out model will be trialled in at least two places, the location and size of which are also undecided.” Considering how long it takes and how much it costs to set up testing models this could be a long time coming. Also another issue is what is being assessed? Is it the same PCEHR model (well documented limitations and poor functionalities) or a new model and who would that be designed by?• “[It] will also assist in evaluating the effectiveness of associated public awareness and information dissemination and education and training for healthcare providers.” We already know this? Based in PCEHR statistics there are relative low registrations (compared to the total Australian population) and access and use is abysmally low. This affirms the most significant factor in the success of e-health implementations as described by Mamlin and Biondich “feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL it will not be used.” (1)1. Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2006:529-33. Epub 2007/01/24.

I applaud the move to an opt-out model. It is however time to move away from pilot's and trials and take bold and definitive steps forward with Australia's National eHealth record. The national eHealth record is currently the only means by which we can integrate care and support effective care handover between hospital, general practice and other providers. The MyHealth record is an essential lynchpin for a more efficient health system. It's also important that patient's have ready access to their health information to support patients to become champions of their own care. There are numerous examples of national records around the world that are now operating successfully that we can learn from- stop hedging bets, and wasting money on half measures and get on with implementation.

I agree Anthony> Lets just get on with it and refine it as we go rather than have a theoretically perfect solution. Just push the doctors to use it by providing a financial penalty if they don't use it and get the opt out model happening and we might achieve a critical mass. Stop buggering around and get on with it!

Phil (& Anthony)-the push you describe has not worked elswhere and in fact has NOT improved care delivery. No matter how hard you push this square PCEHR peg into the round "clinical care hole" it will not fit and the end result is worse than having no peg. In fact the original and current PCEHR model is demonstrating how this 'enforced usage' is not working. Read Coiera's work on building eHealth systems from the 'middle out' recently confirmed by an editorial in the New England Journal of Medicine.

Why not start with the public system and then expand to private. Yes, this is a huge project but if we don't start now it's just delaying the inevitable. Some of the infastructure is already in place in the public system however half-hearted and ill thought out application of current systems and an unwillingness by the hierachi to mandate compliance is costing the public through impacts on clinical outcomes and significant waste of resources. Let's move past the politics to real solutions.

Sue, your comments raise interesting points to discuss. 1. It does not matter too much which domain of the health system we are trying to manage, public or private, because the "information management problems are the same for both. See the “Burning Platform: Overwhelming Complexity” graphic taken from Stead and cited in Hannan TJ, Celia C. Are doctors the structural weakness in the e-health building? Intern Med J. 2013;43(10):1155-64. Epub 2013/10/19.2. Yes, I agree that some of the “infrastructure” is in place however there is very little (?none) interoperability being utilised and this requires national “collaboration”, Such essential “collaboration” does not exist. The kind of “we know best” attitude between governments, states, local health jurisdictions and within individual health institutions. There is no collaboration and it is costing all of us billions as well and not improving health delivery. We are SLOW learners on QUALITY and PATIENT SAFETY. See the outcomes of projects in South Australia, Perth and even New South Wales.a. 2000-To Err Is Human Building a Safer Health System. INSTITUTE OF MEDICINE.b. 2005 -Leape, L.L. and D.M. Berwick, Five years after To Err Is Human: what have we learned? JAMA.c. 2011- Health Information Technology Institute Of Medicine, Health IT and Patient Safety Building Safer Systems for Better Care, The National Academies Press: Washington D.C. d. 2011-Jha, A.K. and D.C. Classen, Getting moving on patient safety--harnessing electronic data for safer care. N Engl J Med. It would be lovely to move beyond the “politics of care” however under a nationalised health care model everyone pays VIA the government’s national policy and they are NOT LISTENING to those who can help. [Coiera E. Why e-health is so hard. Med J Aust. 2013;198(4):178-9. Epub 2013/03/05 and Bowden T, Coiera E. Comparing New Zealand's 'Middle Out' health information technology strategy with other OECD nations. Int J Med Inform. 2013;82(5):e87-95. Epub 2013/01/05.] I could say more however I hope these comments help.